Lucy Hornstein, MD

Why OB/GYNs are not primary care physicians

Physician

March 21, 2013

You may have heard of the “Dean’s Lie“, the artificial padding of numbers allowing medical schools to claim ever-increasing percentages of their graduates are going into primary care medicine. This is accomplished by counting everyone going into internal medicine, pediatrics, and med-peds, in addition to family medicine as “primary care.”

It makes their schools sound more attractive by seeming more progressive, but it does nothing to enhance the supply …

Home genetic testing raises more questions than answers

Lucy Hornstein, MD

Physician

March 12, 2013

A reader recently wrote:

My [spouse] and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a random example, if I knew my chances for getting Alzheimer’s disease were high, I might want to move into assisted living sooner rather than later. We have many questions. Is …

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Home genetic testing raises more questions than answers

How often should I screen for disease?

Lucy Hornstein, MD

Physician

January 1, 2013

Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …

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How often should I screen for disease?

The telephone is obsolete: How my patients contact me today

Lucy Hornstein, MD

Physician

December 4, 2012

“Doctor’s office; please hold.”

You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other …

Why medical students need to begin in the classroom

Lucy Hornstein, MD

Education

October 29, 2012

My esteemed colleague Dr. Bob Centor is enamored of an interesting essay from which he quotes:”Only you can educate you—and you can’t do it by memorizing. You have to find out who you are by experience and by risk-taking, then pursue your own nature intensely. School routines are set up to discourage you from self-discovery. People who know who they are make trouble for schools.”

Personally, I found it more of …

3 unexpected ways to help you lose weight

Lucy Hornstein, MD

Conditions

October 9, 2012

After all the hullabaloo generated by my passing on the accurate but controversial information that exercise will not help you lose weight, I thought I should give equal time to the other side, and discuss several things that appear to help enhance efforts at weight loss.

Sleep

Although I’m not aware of any formal studies documenting this, I can report from personal and professional experience that the value of sufficient …

Practices are getting larger to provide micropractice service

Lucy Hornstein, MD

Physician

September 13, 2012

Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.

Everyone has …

The impact in primary care isn’t always immediate

Lucy Hornstein, MD

Physician

August 21, 2012

Dear NP student who rotated through here back over the winter:

You probably don’t remember seeing this particular woman. I sent you in to do a well-woman exam on her; everything was completely normal. There was nothing particularly memorable about her, either clinically or personally. Just another nice lady coming through the office; just another physical.

You asked her a question, though: “How are things in the bedroom?” She was too shocked …

I love my new EMR, but my staff hates it

Lucy Hornstein, MD

Tech

July 24, 2012

I love my new EMR, which I’ve been using for about 18 months now. I love having all my patients’ information at my fingertips in and out of the office. I don’t miss the piles of paper charts all over the place at all! In short, there’s really nothing about it I don’t like.

My staff, on the other hand, hates it.

Now that they’re not jumping up and down all the …

Design a standardized form for all medical reporting

Lucy Hornstein, MD

Physician

July 8, 2012

One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication.

Design a standardized form for all medical reporting.

Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with …

Most medical students don’t have what it takes for primary care

Lucy Hornstein, MD

Physician

June 19, 2012

I figured it out! I realized what the basic, underlying, fundamental problem is with medical care in this country.

The problem is that it’s too expensive and often isn’t very good, but that’s clear.

The reason medical care in this country is fragmented and overly expensive is that there is a perverse inversion of the correct ratio between primary care and specialty physicians (should be significantly greater than one, instead of significantly …

Saying no to your oncologist is sometimes the right thing to do

Lucy Hornstein, MD

Physician

December 11, 2011

Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously …

There is no such thing as a complete physical examination

Lucy Hornstein, MD

Physician

August 12, 2011

A reader writes, “Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t …

Why pain cannot be a vital sign

Lucy Hornstein, MD

Physician

May 23, 2011

There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand.

The problem is that the word “sign” has a specific meaning in …

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Why pain cannot be a vital sign

Challenge the constitutionality of EMTALA

Lucy Hornstein, MD

Policy

March 11, 2011

Here is a letter to the editor in a recent Philadelphia Inquirer:

… In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.

In essence, we had federally mandated national health care – signed …

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Challenge the constitutionality of EMTALA

A modest proposal for a truly useful EMR

Lucy Hornstein, MD

Tech

January 7, 2011

I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans.

Stop laughing. I really mean it.

I do not believe, however, that IT best serves the medical needs of our patients when …

Preventive care as a cost saving measure is a fallacy

Lucy Hornstein, MD

Policy

November 12, 2010

I like reading Maggie Mahar’s Health Beat.

She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …

What’s the difference between family practice and med-peds?

Lucy Hornstein, MD

Physician

September 26, 2010

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that …

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What’s the difference between family practice and med-peds?

Medicine is an old profession, but not the oldest profession

Lucy Hornstein, MD

Physician

August 22, 2010

Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as …

Understanding balance billing, a primer for patients

Lucy Hornstein, MD

Policy

July 21, 2010

The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.

Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …

Lucy Hornstein, MD

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